Annie Heiderscheit

Bio: Annie Heiderscheit is an academic researcher from Augsburg College. The author has contributed to research in topics: Music therapy & Randomized controlled trial. The author has an hindex of 7, co-authored 25 publications receiving 342 citations. Previous affiliations of Annie Heiderscheit include University of Minnesota.

Effects of patient-directed music intervention on anxiety and sedative exposure in critically Ill patients receiving mechanical ventilatory support: A randomized clinical trial

Abstract: Importance Alternatives to sedative medications, such as music, may alleviate the anxiety associated with ventilatory support. Objective To test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients. Design, Setting, and Patients Randomized clinical trial that enrolled 373 patients from 12 intensive care units (ICUs) at 5 hospitals in the Minneapolis-St Paul, Minnesota, area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86% were white, 52% were female, and the mean (SD) age was 59 (14) years. The patients had a mean (SD) Acute Physiology, Age and Chronic Health Evaluation III score of 63 (21.6) and a mean (SD) of 5.7 (6.4) study days. Interventions Self-initiated PDM (n = 126) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, self-initiated use of noise-canceling headphones (NCH; n = 122), or usual care (n = 125). Main Outcomes and Measures Daily assessments of anxiety (on 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency). Results Patients in the PDM group listened to music for a mean (SD) of 79.8 (126) (median [range], 12 [0-796]) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean (SD) of 34.0 (89.6) (median [range], 0 [0-916]) minutes/day. The mixed-models analysis showed that at any time point, patients in the PDM group had an anxiety score that was 19.5 points lower (95% CI, −32.2 to −6.8) than patients in the usual care group (P = .003). By the fifth study day, anxiety was reduced by 36.5% in PDM patients. The treatment × time interaction showed that PDM significantly reduced both measures of sedative exposure. Compared with usual care, the PDM group had reduced sedation intensity by −0.18 (95% CI, −0.36 to −0.004) points/day (P = .05) and had reduced frequency by −0.21 (95% CI, −0.37 to −0.05) points/day (P = .01). The PDM group had reduced sedation frequency by −0.18 (95% CI, −0.36 to −0.004) points/day vs the NCH group (P = .04). By the fifth study day, the PDM patients received 2 fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity. Conclusions and Relevance Among ICU patients receiving acute ventilatory support for respiratory failure, PDM resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH. Trial Registration clinicaltrials.gov Identifier: NCT00440700

A Tool for Music Preference Assessment in Critically Ill Patients Receiving Mechanical Ventilatory Support.

Abstract: Music is an ideal intervention to reduce anxiety and promote relaxation in critically ill patients. This article reviews the research studies on music-listening interventions to manage distressful symptoms in this population, and describes the development and implementation of the Music Assessment Tool (MAT) to assist professionals in ascertaining patients' music preferences in the challenging, dynamic clinical environment of the intensive care unit (ICU). The MAT is easy to use with these patients who experience profound communication challenges due to fatigue and inability to speak because of endotracheal tube placement. The music therapist and ICU nursing staff are encouraged to work collaboratively to implement music in a personalized manner to ensure the greatest benefit for mechanically ventilated patients.

Use of the Iso Principle as a Central Method in Mood Management: A Music Psychotherapy Clinical Case Study

Abstract: The iso principle was introduced in the late 1940s as a method of mood management (Altshuler, 1948). Over time, music therapists have discovered a variety of ways to expand and utilize the iso principle in a variety of clinical settings (Smeijesters, 1995; Crowe, 2004; Michel & Pinson, 2005; Wigram, Pedersen, & Bonde, 2002). The purpose of this article is to explore the use of the iso principle as a method of music management from its roots and into modern-day clinical practice. A method utilizing the iso principle for mood management is introduced and illustrated through a case study to demonstrate the process, implementation, and efficacy of this method.Review of LiteratureThe impact of music on emotion has consistently been a focus and area of interest in music therapy, music psychology, and related fields (Shatin, 1970; Boothby & Robbins, 2011; Punkanen, Eerola, and Erkkila 2011). Developments in the fields of counseling psychology, psychiatry, and neuroscience have expanded the understanding and possibilities for those interested in music and emotion. The development of knowledge and information can inform music therapists and related practitioners regarding the means of using music to facilitate psychological changes of emotion in order to benefit those suffering from mood disorders (Punkanen, Eerola, and Erkkila 2011) and to develop evidence-informed and evidence-based practices.Research in these related fields regarding music and emotion is significant in demonstrating that, overall, emotional states connect with many systems in the body that influence emotional and cognitive changes, along with physiological and motor expression (IIie & Thompson, 2011). Neuroimaging studies demonstrate that music-evoked emotions engage the core structures of emotional processing, leading researchers to view music-evoked emotions as having biological similarity to everyday emotions (Koelsch, Offermanns, & Franzke, 2010; Koelsch, Siebel, & Fritz, 2010). Understanding that emotions evoked in listening to music hold the same neurological experience as day-to-day emotions provides support for the use of music to shift affect and mood.Numerous music therapy interventions and techniques have been studied as a means of facilitating emotional change, specifically improvisation, the Bonny Method of Guided Imagery in Music (BMGIM) (Summer, 1988; Bush, 1992; Walker, 1993; Weiss, 1994; McKinney, Antoni, Kumar, & Kumar, 1995; Scott, 2007-2008), Analytical Music Therapy (Priestly & Eschen, 2002), and lyric analysis (Crowe, 2004). The impact of music therapy on mood management has been explored through music therapy processes that have focused on individual work as well as group-oriented approaches (Holland, 1995; Smeijsters, 1995).Researchers have explored the use of music listening and its impact on mood. Sarkamo et al. (2008) discovered that when they implemented a self-selected music listening protocol with stroke patients, those patients demonstrated significantly less depressed or confused mood states. Lesuik (2010) utilized a preferred music listening protocol with information technology professionals and found a significant improvement in mood state. Biagini et al. (2012) implemented a music listening intervention for athletes in training. They found that listening to music significantly altered mood state and improved performance. Lai (1999) found that utilizing music listening with depressed women helped them shift from a depressed mood state to a tranquil mood state.While music listening has demonstrated effectiveness in altering and improving mood states, it is also an intervention that is beneficial for several reasons. Music listening is a non-pharmacological intervention and can be implemented as a patient-controlled intervention (Heiderscheit, Chian, & Donely, 2001; Heiderscheit, Breckinridge, Chian, and Savik, 2013). A patient-controlled intervention allows the patient to use the intervention whenever they want or need for as long as they want or need. …

Decreasing Delirium through Music (DDM) in critically ill, mechanically ventilated patients in the intensive care unit: study protocol for a pilot randomized controlled trial.

Abstract: Delirium is a highly prevalent and morbid syndrome in intensive care units (ICUs). Changing the stressful environment within the ICU via music may be an effective and a scalable way to reduce the burden of delirium. The Decreasing Delirium through Music (DDM) study is a three-arm, single-blind, randomized controlled feasibility trial. Sixty patients admitted to the ICU with respiratory failure requiring mechanical ventilation will be randomized to one of three arms (20 participants per arm): (1) personalized music, (2) non-personalized relaxing music, or (3) attention-control. Music preferences will be obtained from all enrolled participants or their family caregivers. Participants will receive two 1-h audio sessions a day through noise-cancelling headphones and mp3 players. Our primary aim is to determine the feasibility of the trial design (recruitment, adherence, participant retention, design and delivery of the music intervention). Our secondary aim is to estimate the potential effect size of patient-preferred music listening in reducing delirium, as measured by the Confusion Assessment Method for the ICU (CAM-ICU). Participants will receive twice daily assessments for level of sedation and presence of delirium. Enrolled participants will be followed in the hospital until death, discharge, or up to 28 days, and seen in the Critical Care Recovery Clinic at 90 days. DDM is a feasibility trial to provide personalized and non-personalized music interventions for critically ill, mechanically ventilated patients. Our trial will also estimate the preliminary efficacy of music interventions on reducing delirium incidence and severity. ClinicalTrials.gov, Identifier: NCT03095443 . Registered on 23 March 2017.

Instituting a music listening intervention for critically ill patients receiving mechanical ventilation: Exemplars from two patient cases.

Abstract: Music is an ideal intervention to reduce anxiety and promote relaxation in critically ill patients receiving mechanical ventilatory support. This article reviews the basis for a music listening intervention and describes two case examples with patients utilizing a music listening intervention to illustrate the implementation and use of the music listening protocol in this dynamic environment. The case examples illustrate the importance and necessity of engaging a music therapist in not only assessing the music preferences of patients, but also for implementing a music listening protocol to manage the varied and challenging needs of patients in the critical care setting. Additionally, the case examples presented in this paper demonstrate the wide array of music patients prefer and how the ease of a music listening protocol allows mechanically ventilated patients to engage in managing their own anxiety during this distressful experience.

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

Abstract: Objective:To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU.Design:Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups g

Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

Abstract: In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade "A" (strong recommendation), Grade "B" (recommendation) and Grade "0" (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

Post-intensive care syndrome: its pathophysiology, prevention, and future directions

Abstract: Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long-term prognoses. Post-intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long-term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS-p) and the mental status of their family (PICS-F). Intensive care unit-acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow-up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.

Effects of patient-directed music intervention on anxiety and sedative exposure in critically Ill patients receiving mechanical ventilatory support: A randomized clinical trial

Abstract: Importance Alternatives to sedative medications, such as music, may alleviate the anxiety associated with ventilatory support. Objective To test whether listening to self-initiated patient-directed music (PDM) can reduce anxiety and sedative exposure during ventilatory support in critically ill patients. Design, Setting, and Patients Randomized clinical trial that enrolled 373 patients from 12 intensive care units (ICUs) at 5 hospitals in the Minneapolis-St Paul, Minnesota, area receiving acute mechanical ventilatory support for respiratory failure between September 2006 and March 2011. Of the patients included in the study, 86% were white, 52% were female, and the mean (SD) age was 59 (14) years. The patients had a mean (SD) Acute Physiology, Age and Chronic Health Evaluation III score of 63 (21.6) and a mean (SD) of 5.7 (6.4) study days. Interventions Self-initiated PDM (n = 126) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, self-initiated use of noise-canceling headphones (NCH; n = 122), or usual care (n = 125). Main Outcomes and Measures Daily assessments of anxiety (on 100-mm visual analog scale) and 2 aggregate measures of sedative exposure (intensity and frequency). Results Patients in the PDM group listened to music for a mean (SD) of 79.8 (126) (median [range], 12 [0-796]) minutes/day. Patients in the NCH group wore the noise-abating headphones for a mean (SD) of 34.0 (89.6) (median [range], 0 [0-916]) minutes/day. The mixed-models analysis showed that at any time point, patients in the PDM group had an anxiety score that was 19.5 points lower (95% CI, −32.2 to −6.8) than patients in the usual care group (P = .003). By the fifth study day, anxiety was reduced by 36.5% in PDM patients. The treatment × time interaction showed that PDM significantly reduced both measures of sedative exposure. Compared with usual care, the PDM group had reduced sedation intensity by −0.18 (95% CI, −0.36 to −0.004) points/day (P = .05) and had reduced frequency by −0.21 (95% CI, −0.37 to −0.05) points/day (P = .01). The PDM group had reduced sedation frequency by −0.18 (95% CI, −0.36 to −0.004) points/day vs the NCH group (P = .04). By the fifth study day, the PDM patients received 2 fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity. Conclusions and Relevance Among ICU patients receiving acute ventilatory support for respiratory failure, PDM resulted in greater reduction in anxiety compared with usual care, but not compared with NCH. Concurrently, PDM resulted in greater reduction in sedation frequency compared with usual care or NCH, and greater reduction in sedation intensity compared with usual care, but not compared with NCH. Trial Registration clinicaltrials.gov Identifier: NCT00440700

Journal of the American Medical Association

Abstract: Parkinson Disease P arkinson disease involves the nervous system, specifically, movement and control of muscles. Parkinson disease affects more than 1 million individuals in the United States. Because it is more common in older persons, the incidence (number of new cases) of Parkinson disease is increasing as the population grows older. Parkinson disease was first described in 1817 and was originally called " shaking palsy. " Medical researchers later discovered that parkinsonian symptoms were due to degeneration of nerve cells in an area of the brain called the substantia nigra. These cells supply dopamine, a chemical that modulates movement, to other areas of the brain called the basal ganglia. Parkinson disease is progressive and leads to severe limitations in activity and quality of life if the disorder is not treated. Neurologists (doctors who specialize in treating diseases of the nervous system) and neurosurgeons (doctors who specialize in surgery of the nervous system) individualize each person' s treatment to manage the symptoms and slow the progress of Parkinson disease. The January 21, 2004, issue of JAMA includes an article about treatment of Parkinson disease. The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424. • Levodopa (a synthetic medication) replaces dopamine for patients with Parkinson disease, improving symptoms of tremor and rigidity. • Carbidopa helps reduce adverse effects of levodopa and increases the amount of dopamine in the brain (and not in the rest of the body). • Several other medications are available to decrease symptoms or slow the progression of Parkinson disease. • Antidepressants may be prescribed if depression occurs. • Pallidotomy—a probe delivering electrical current is used to create a permanent lesion (scar) in a specific area of the brain (the globus pallidus) to lessen rigidity, tremor, and abnormal movements (dyskinesias). • Thalamotomy—electrical current creates a small, permanent lesion in the area of the brain called the thalamus. This helps reduce tremor and rigidity. • Deep brain stimulation—an electrode is placed into a specific deep brain structure. Electrical …